Smalltest nr 3 Flashcards
Painkilling list
- Opioids
- NSAIDS
- ⍺-2 agonists
- Antibodies against nerve growth factor
- Gabapentin
- Antidepressants
+ KETAMIN (NMDA receptor antagonist)
Gabapentin used for (indication)
- Anti epileptic
- Unique for NEUROPATHIC PAIN
What are the major pilars due to painkilling?
- Opioids
- NSAIDS
Name an NSAIDS agianst headache
ASPIRIN
What are the requirements for surgery
General Anaestesia
- Total unconsciousness
- Total muscle relaxation
- Total analgesia
NOT= ANALGESIA or NEUOROLEPTIC
What is balanced anesthesia?
Balanced anesthesia - GS reached with combinations of drugs
Eg. ⍺-2 agonists with:
1. KETAMIN
2. BUTORPHANOL = Opioid
3. XYLAZINE - Emesis induction - cat - Subsedative dose
Used for predemication, induction and wide maintenance
BUTORPHANOL
Type of drug
Opioid
KETAMIN
Type of drug
NMDA receptor antagonist
Opioids and analgesia?
VERY POTENT ANALGESIC
Higher dose of Xylazine or Detomidine cause analgesic effect?
True or false
True
The higher dose of Xylazine or detomine, the more POTENT analgesic effect of the ⍺-2 agonists substance!
Induces painkilling effect of the other substances.
What are the different tests performed to evaluate pain and pain perceptions?
- Tail flinch test
- Hot plate test
- “Sigmund” (Wrighting) test
Characterize the Tail flinch test
- Lab animals is used
- At least 2 groups.
- One is placebo - Focused infra red light
- heat up tissue of tail = causes pain within seconds!
- Mouse will pull away the tail. - Measure the time
Characterize the Hot plate test
- Easier to measure than tail flinch test
- Hot plate heated to 54 degrees celsius
- Measure the time until mouse lift up its feets to lick its foot.
Tail flinch latency graph
- Measure tailflinch with and withouth painkilling subst.
- Administration route is important - IV or IM
1. Using MORPHINE
(GA, premedication or during maintenance) - Wait 20-30 min!! Time to reach morphines maximal painkilling activity! Before that not enough painkilling effect if you use MORPHINE alone as a painkiller.
- In surgery, wait 20-30 min prior to cut the animal
- Compared with the control group = Proove of painkilling effect! = By having morphine In the system, they can endure pain for more seconds (3 sec)
Characterize the WRIGHT (SIGMUND) test
- NO LONGER USED because of animal welfare
- Measure number of convulsions
- Use substance to induce pain (Algogenic, 1% acid)!
- Given IP = VERY PAINFUL
- As PANCREATITIS!!! And PERITONITIS!!! - Due to convulsions you will be able to detect a time dependent efficacy
- ⍺-2 agonists -> detomidine > xylazine in regards of potency, ↑dose = ↑ potency
Detomidine VS Xylazine due to convulsions and analgesic effect
DETOMIDINE is a more POTENT ANALGESIC, so less convulsions will be seen compared to Xylazine.
↑dose = ↑ potency
Druggroups used as premedications prior to GA
- PHENOTHIAZINES
- BUTYROPHENONES
- ⍺-2 AGONISTS
- BZD (BENZODIAZEPINES)
Name the Tranquilizer groups
- PHENOTHIAZINES
- BUTYROPHENONES
Characterize the TRANQULIZER drug group
- Used for Traveling
- Cause Sedation ONLY (Level of CNS depression)
- ↑dose = ↑ duration
Name the Sedatohypnotic drug groups
- ⍺-2 AGONISTS
- BZD (BENZODIAZEPINES)
- Phenobarbital=Barbiturates
Characterize the Sedatohypnotic drug group
- Not enough for surgery on its own
- ↑ High dose = Hypnosedation, Low dose = Sedation
(level of CNS depression)
PHENOTHIAZINE
Drugs
= Tranquilizers
Acepromazine
BUTYROPHENONES
Drugs
= Tranqulizers
AZAPERONE
DROPERIDOL
FLUANISONE
Characterize the GA drug group
- Cause the debth enough of CNS depression to cause general anesthesia!
- Inhalations and Injections
- Elevation of dose on the graph indicates that it needs to be monitored => Danger of EUTHANASIA!
⍺-2 AGONISTS
Drugs
XYLAZINE
DETOMIDINE
MEDETOMIDINE
DEXMEDETOMIDINE
- BZD (BENZODIAZEPINES)
Drugs
DIAZEPAM
MIDAZOLAM
(Alprazolam)
PHENOTHIAZINES
(Acepromazine)
Sedation
Yes + (++)
PHENOTHIAZINES
(Acepromazine)
Analgesia
No analgesic effect, however, it potentiates the analgesic effect of other drugs
PHENOTHIAZINES
(Acepromazine)
Administration route
IV, (IM)
Po -> bioavailability is unreliable (individual independent)
Acepromazine NOT reliable ORALY
Oral DOG and HORSES - for sedate for minor procedure or transport to practice - one will have an effect and other not
PHENOTHIAZINES
(Acepromazine)
Indication
- Transportation (calming),
- Premedication,
- Neuroleptic-analgesia (NOT for GA)
Acepromazine -> used to fight histamin effect
= antihistamine
UNIQUE INDICATION (morphine cause histamine release, use acepromazine to avoid this)
4. Anti-emesis = anti vomit - motion sickness
PHENOTHIAZINES
(Acepromazine)
Side effects
- Hypotension (⍺-1),
- penile prolapse (eq),
- 3rd eyelid prolapse (ca, fe),
- ↑ Pseudopregnancy duration (ca),
- Thermoregulation = lost (esp. acepromazine)
- Tissue irritant
- Can be paifull IM
- In small animals - Decreased GI activity
- Tympanism (ru)
PHENOTHIAZINES
(Acepromazine)
Contraindications
- Dehydration (⍺-1 -> hypotension),
- history of epileptic seizures, advised not to use
- Ulcers
- ACEPROMAZINE NOT for BOXERS
BUTYROPHENONES
Sedation
Yes + (++)
BUTYROPHENONES
Analgesia
No analgesic effect, however, it potentiates the analgesic effect of other drugs
- Slightly analgesic in comparance to acepromazine
BUTYROPHENONES
Administration route
- IM only
(due to ⍺-1 agonist, it can cause hypotension so severe, that patient can collapse) - AZAPERONE - Swine - reduce stress traveling = ONLY ORAL
BUTYROPHENONES
Indications
- Transportation (calming),
- premedication,
- neuroleptic-analgesia (butyrophenones -> combine with opioids -> provides muscle relaxation, sedation & mild analgesia) = ONLY MINOR PROCEDURES not GA
What is Neuroleptic-analgesia
Tranquilizers + opioids
Butyrphenones + opioids
Especially used in EXOTIC ANIMALS
BUTYROPHENONES
Sideeffects
- Hypotension (⍺-1),
- penile prolapse (eq),
- 3rd eyelid prolapse (ca, fe),
- increase pseudopregnancy duration (ca),
- thermoregulation = lost (esp. acepromazine)
BUTYROPHENONES
Contraindications
- Dehydration (⍺-1 -> hypotension),
- History of epileptic seizures,
- Butyrophenones have a LONG duration(halflife) =Ø use for transport! Not allowed for slaughter-transport?
Indication
Droperidol
Fluanisone
Other than sedation due to examination or transport (tranquilizers)
Used as premedication prior to surgery
⍺-2 AGONISTS
Sedation
Yes
+++
⍺-2 AGONISTS
Analgesia
+++
Yes
⍺-2 AGONISTS
From least -> most selective
meaning
- Xylazine
- Detomidine
- Medetomidine
- Dexmedetomidine
Meaning that:
- Xylazine is the least selective = most side-effects
- Dexmedetomidine is the most selective = least side-effect and is also alowed in cardiac patients.
⍺-2 AGONISTS
Administration Route
IM, IV
Po -> no swallowing!!
Absorption via buccal application (gel) - DEXMEDATOMIDINE (Ca, Fe)
⍺-2 AGONISTS
Indications
- Alone -> minor procedures
(e. g. ear cleaning, wound bandaging) - Combo
-> e.g. with ketamine -> balanced anaesthesia
Fe -> xylazine = emesis (subhypnotic dose)
Combination to later perform GA
⍺-2 AGONISTS
Side effects
- Vomiting, emesis,
- SIDE effects due to ⍺-1 agonism
-> Ø heart failure patients
(dexmedetomidine can be used in heart failure patients), –> Ø diabetic patients because it can increase glucose blood levels
Sideeffects depending on the SENSITIVITY of the ⍺1 or ⍺2 receptor
⍺-2 AGONISTS
Contraindications
Cardiac failure patients, diabetic patients
(dexmedetomidine can be used in heart failure patients),
BDZ
Sedation
(Diazepam, midazolam)
Yes, +
Depending on the dose and indication
BDZ
Analgesia
(Diazepam, midazolam)
No —
BDZ
Administration rout
IV
Intranasally, IV, rectally
IM -> not reliable for diazepam
(midazolam IM absorption is good enough)
Po -> alprazolam (xanax; used for phonophobia (ca)
BDZ
Indications
- Premedication,
- sedation & hypnosis,
- anticonvulsant (status epilepsy),
fe-> diazepam is used to increase appetite
(short term, because it can cause irreversible liver damage) Not longer than 5-7 days!
BDZ
Side effects
Hepatotoxic, weight gain
BDZ
Contraindication
Fe & usage of diazepam
Phenobarbital
Sedation
Phenobarbital
Analgesia
No
- -
Phenobarbital
Administration route
Po, maybe IV
Phenobarbital
Indications
Long term management of epilepsy
Phenobarbital
Side effects
- Weight gain,
- hepatotoxic,
- CYP450 inducer!!
(speeds up the metabolism of itself and other drugs metabolized by cytochrome enzymes => increase the dose)
Phenobarbital
contraindications
Not 1st choice in liver failure patients
Morphine, fentanyl
Category
Full agonist
Morphine, fentanyl
Analgesic potency
+++
Morphine, fentanyl
Sedation
++
Morphine,
Duration of action
Morphine - 3-4 hrs
Give continuous rate infusion
(can govern anesthesia a lot safer)
Fentanyl
Duration of action
Fentanyl - bolus = 20-30 min
Give continuous rate infusion
(can govern anesthesia a lot safer)
For injectable anaesthesia - fentanyl
Morphine, fentanyl
Side effects
- Respiratory depression,
- emesis, (depends on the drug)
- histamine release (acepromazine use to counter this), 4. anti-diarrhea,
- apomorphine (eyedrops, SC) -> very strong emesis effects… wear gloves or wash hands STORY, injections
Use of bolus in such as fentanyl
Bolus -> the administration of an amount of drug given at once (for fentanyl, must then readminister every 20 min)
Drugs belonging to OPIOIDS
- Morphine
- Fentanyl
- Tramadol
- Buphrenorphine
- Butorphanol
Indication of opioids
- Pain killing effect
- Used for its side effects
- Emesis = APOMORPHINE
- Anti-diarrhoea = LOPERAMIDE
Drug used to induce emesis
APOMORPHINE
Drug used for anti-diarrhoea
LOPERAMIDE
Tramadol
Category
Partial Agonist
Tramadol
Sedation
No -
(however, long term Po, the patient can appear sedated)
Tramadol
Analgesic potency
+
Tramadol
Duration of action
6-8 hours
Tramadol
Side effects
- Respiratory depression,
- emesis,
- histamine release
(acepromazine use to counter this), - anti-diarrhoea,
apomorphine (eyedrops, SC) -> very strong emesis effects… wear gloves or wash hands
Buprenorphine
Category
Partial agonist
Buprenorphine
Analgesic potency
++
Buprenorphine
Sedation
+
(dependent on dose & individual)
Moderatly
Buprenorphine
Duration of action
6-8 hrs (can be up to 12 hrs) = Half a day
BID
1st choice in case of PANCREATITIS
= Because NSAIDS is not allowed
ButorPhanol
Category
Partial agonist
Butorphanol
Analgesic potency
+
Butorphanol
Sedation
+
(dependent on dose & individual)
Moderate
Butorphanol
Duration of action
3-4 hrs
Butorphanol
Side effects
- Respiratory depression,
- emesis,
- histamine release (acepromazine use to counter this), 4. anti-diarrhoea,
apomorphine (eyedrops, SC) -> very strong emesis effects… wear gloves or wash hands
Due to analgesic potency in which order does the mentioned opioids come in
- Morphine, Fentanyl
- Buprenorphine
- Tramadol/Butorphanol
Situation task I.
Dog with heartworm disease
5 years old, slightly decompensated heart failure
Melarsomine: sedation-analgesia necessary What should we give?
Keywords:
- Heartworm disease,
- Slightly Decompensated heart failure
With heartworm disease, there are 2 ways to administer medicine:
A) slow;
B) complex therapy (fast)
-> use when patient has decompensated heart failure
MELARSOMIDE (immiticide)
-> sedation-analgesia is necessary (it is very painful!)
What to give?
Benzodiazepine & opioids (combined)
When do we use the complex (fast theraphy) in case of heart worm disease?
use when patient has decompensated heart failure
When performing complex (fast) therapy in case of Heartworm disease, which drug is used?
MELARSOMIDE (immiticide) = Arsenic compound
- > sedation-analgesia is necessary (it is very painful!)
- > Given IM into Lumbar Muscle
- > While Sedated
What to give together with the painful MELARSOMIDE (immiticide) ?
No need for general anesthesia
BENZODIAZEPINE(BZD) & OPIOIDS (combined)
-> sedation-analgesia is necessary because MELARSOMIDE is really painful
Situation task II.
Dog with severe trauma
Stabile general condition (3 years old, no known disease) Amputation inevitable
Which drugs should we use for premedication?
- Phenothiazine
- ⍺-2 agonist
- Benzodiazepines
- Ketamine
- Lidocaine
Situation task II.
Dog with severe trauma
Stabile general condition (3 years old, no known disease) Amputation inevitable
Which drugs should we use for premedication?
WHY do we use them?
- Phenothiazine
- > potentiate the analgesic effect
- > Acepromazine - ⍺-2 agonist
- > increase painkilling efficacy - Benzodiazepines
- > can prevent pre & post-anesthesia excitement
- > Used as premedication as well - Ketamine
-> IV & has an analgesic effect (NMDAr antagonist), given at continuous rate (at subanesthetic dose), decreases sensitization of pain
= Injectable anesthetic with IMPORTANT ANALGESIC effect - Lidocaine
- > local anesthetic, use around nerve where you’re going to cut the leg off
Why does pre and post narcotic excitation happen?
During General Anesthesia
- pre and post excitatation can happen depending on the individual, the drug, and the combination of the drug
How to avoid pre and post narcotic excitation?
Mostly we can avoid this pre and post narcotic excitation. Prevented mostly by Benzodiazepines..
Characterize KETAMIN
Decrease the sensitization to pain
Act on the NMDA receptor
Used in combination with ⍺-2 agonist in order to perform balanced anesthesia
Which type of drug cannot be used in diabetic patients
⍺-2 agonists
Because it can increase blood glucose level
Which type of drug cannot be used in cardiac failure patients? With the exception of one drug.
⍺-2 agonist
Dexmedetomidine can be used in heart failure patients (gel-buccal)
Sideeffects of the ⍺-2 agonist depend on
The sensitivity of the ⍺1 and ⍺2 receptor
